KanCare red tape continues to delay funds

By Rod Haxton, editor

In the continuing battle to begin getting money through the newly implemented KanCare program, Park Lane Nursing Home is finding very little success as it tries to negotiate unfamiliar bureaucracy.

According to officials with the Scott City nursing home, they have begun getting a trickle of money from one of the three care managed organizations (CMOs) assigned to operate the program for individuals on Medicaid, but it’s falling far short of meeting their operating expenses.

Park Lane has yet to receive about $120,000 in Medicaid expenses that were billed for January plus another $40,000 so far in February.

In billing delays unrelated to KanCare, the nursing home has yet to receive about $34,000 in expenses that were billed to Medicare. That is part of the home’s more recent transition to Part A and Part B certification in which they are now capable of providing swing bed and physical therapy care.

The state’s KanCare program, however, is providing the biggest headache for Park Lane and other long-term care providers who are also experiencing delays in getting reimbursed from one of the three CMOs under contract to Kansas.

Jeff Head, CEO of H&M Healthcare which is providing consulting services to Park Lane, says some payments have arrived from UnitedHealthcare, one of three companies which were awarded a state contract.

Reimbursement for residents assigned to either Amerigroup or Sunflower State Health Plan have been non-existent.

“Claims are being lost in the bureaucracy,” Head advised Scott County commissioners on Tuesday afternoon. “We may have to rebill for those services again. The MCOs can’t tell us what’s going on.”

Head and Park Lane Administrator Nicole Turner have been on the phone repeatedly with representatives from the MCOs, but “we’ve been getting the bureaucratic runaround,” he says.

Head says it may be another 2-3 weeks before Park Lane “will start getting any significant money” from the MCOs, but that’s no guarantee. Park Lane has already received a $161,475 “loan” from the county to help meet payroll and other short-term expenses.

Of that amount, $23,550 covers the final bill for building renovation and $19,461 is for new laundry and kitchen equipment. The county will pick up the tab for building maintenance and work related to the original renovation project.

Park Lane will repay $118,463 which represents what is owed by the state in KanCare payments.

Holding on for Now

Park Lane Administrator Nicole Turner says the county’s loan should carry the nursing home for the next 3-4 weeks. In addition to utility, food and other day-to-day costs, the nursing home must meet payroll of $80,000 to $85,000 every two weeks.

With partial payments coming from one of the MCOs, along with private pay residents, Turner feels the nursing home can get through the next couple of pay periods without asking for additional money from the county.

“Hopefully, by then, the state and the MCOs will have some things worked out,” she says.

H&M Healthcare, which owns and operates nursing homes in Texas, has seen a similar funding dilemma with adoption of a nearly identical program of dealing with Medicaid residents. The Texas version of KanCare was put into effect in March of 2012.

Head says the ongoing struggle to implement the program and get reimbursed for services has been “ugly.”

“We have fought this for months and we still are to some extent,” he says. “Insurance companies are clueless when it comes to working with extended care facilities.”

Census is Steady

While the nursing home is trying to work through it’s short-term financial problems, Head feels the long-term picture is continuing to look good.

There are currently 65 residents in the nursing home and another 10 in Park Place Apartments.

“With this census, the facility will cash flow quite easily,” he noted. “It’s very viable.”

That process will be made much easier when the nursing home can begin receiving a reliable flow of money through the MCOs, Head added.